Recommendations on Cervical Cancer Screening

The Committee on Practice Bulletins–Gynecology of the American College of Obstetricians and Gynecologists (ACOG) has issued a new, evidence-based practice bulletin on cervical cancer screening. “ACOG Practice Bulletin Number 45: Cervical Cytology Screening,” appears in the August 2003 issue of Obstetrics and Gynecology.

According to ACOG, an increasing number of women no longer need annual testing for cervical cancer, and screening can begin later than previously recommended. However, annual pelvic examinations are still advised for women across a broad age range.

ACOG's new recommendations differ slightly from the recently revised recommendations of the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF). Among the new ACOG recommendations are the following:

• The first screening of cervical cytology should occur by approximately three years after first sexual intercourse or by age 21, whichever comes first. (Previously, ACOG called for screening by the onset of sexual activity or by age 18, whichever occurred first.)

• Women younger than 30 years should have cervical cytology screening annually, because these women have a higher likelihood than older women of acquiring high-risk types of human papillomavirus. (Previously, ACOG did not distinguish between age groups.)

• If a woman 30 years or older has negative results on three consecutive annual cervical cytology tests, then she may be rescreened with cervical cytology alone every two to three years.

• No matter what recommended interval for cervical cytology testing a woman follows, data indicate that both liquid-based and conventional methods of cervical cytology are acceptable for use in testing.

• More frequent cervical screening may be required for higher-risk women who have human immunodeficiency virus infection, are immunosuppressed (such as those who have received a kidney transplant), were exposed to diethylstilbestrol in utero, or were previously diagnosed with cervical cancer.

• Women who have undergone hysterectomy with removal of the cervix for benign reasons and with no history of abnormal or cancerous cell growth may discontinue routine cytology testing. Women who have had such a hysterectomy but who have a history of abnormal cell growth (classified as cervical intraepithelial neoplasia [CIN] 2 or 3) should be screened annually until they have three consecutive, negative vaginal cytology tests; then they can discontinue routine screening.

• Physicians can determine on an individual basis when an older woman can stop having cervical cancer screenings, based on such factors as her medical history and the physician's ability to monitor the patient in the future. (The ACS calls for cessation of testing in non–high-risk women at age 70, and the USPSTF by age 65; ACOG notes that because of limited studies of older women, it is difficult to set an across-the-board upper age limit for cervical cancer screening.)

Public Awareness Campaigns on Antibiotic and OTC Drug Safety

The Centers for Disease Control and Prevention and the U.S. Food and Drug Administration have launched a new public awareness campaign on antibiotic overuse.

The campaign, entitled “Get Smart,” seeks to promote the appropriate use in the community of antibiotics for upper respiratory infections, and aims to increase knowledge and awareness of appropriate antibiotic use. Patient education materials are available free of charge online athttp://www.cdc.gov/getsmart.

A similar campaign seeks to promote the safe and appropriate use of nonprescription, over-the-counter (OTC) medications. The campaign, entitled “Be MedWise,” is spearheaded by the National Council on Patient Information and Education (NCPIE). Patient information materials in English and Spanish on choosing appropriate OTC medications are available free of charge online athttp://www.bemedwise.org. Detailed information about the OTC drug facts label and how to compare products, learn about dosages, and understand information about specific warnings also is included.

Childhood and Adolescent Tobacco Risk Assessment

Physicians should screen for smoking risk factors in children beginning at age 10, according to an article on tobacco control by Sargent and DiFranza. “Tobacco Control for Clinicians Who Treat Adolescents” was published in the March/April 2003 issue of CA: A Cancer Journal for Clinicians and is available online athttp://onlinelibrary.wiley.com/journal/10.3322/(ISSN)1542-4863.

Smoking remains the most common preventable cause of death in the developed world and is becoming an important cause of death in the developing world. The onset of tobacco use typically occurs during childhood or adolescence.

Physicians can develop a risk profile for tobacco use by a patient's response to 10 questions relating to exposure to social influences, attitudinal susceptibility, school performance, and parental attitudes about smoking. Teenagers who already smoke should be assessed for signs of nicotine dependence. Physicians should not assume that adolescent smokers are not interested in quitting; the results of six surveys have showed that 71 to 83 percent of teenaged smokers had attempted to stop.

Physicians should ask teenagers about tobacco use; advise tobacco users to stop; assess their willingness to stop; assist them in making a plan to stop; and arrange for follow-up.

Cancer Statistics for Hispanics

An estimated 67,400 Hispanics will be diagnosed with cancer in 2003, and approximately 22,100 will die from cancer, according to a report from the American Cancer Society. “Cancer Statistics for Hispanics, 2003” was published in the July/August 2003 issue of CA: A Cancer Journal for Clinicians and is available online athttp://onlinelibrary.wiley.com/journal/10.3322/(ISSN)1542-4863.

Hispanics have lower cancer rates and mortality rates from all cancers combined and from the four most common cancers (i.e., breast, prostate, lung and bronchus, and colon and rectum) than non-Hispanic whites. However, Hispanics have higher cancer rates and higher mortality rates from cancers of the stomach, liver, uterine cervix, and gall-bladder. These rates reflect greater exposure to specific infectious agents and lower rates of screening for cervical cancer, as well as dietary and possible genetic factors.

Strategies to reduce cancer rates among Hispanics include interventions to increase screening and physical activity, and reductions in tobacco use and obesity. Several statistics suggest that Hispanics smoke less than non-Hispanic whites, but several factors may make Hispanics susceptible to smoking. Obesity, which has been associated with an increased risk for certain cancers, is increasing among Hispanics, especially women. Physical activity rates also are lower in Hispanics compared with non-Hispanic whites.